title: Neuroimaging, behavioral, and psychological sequelae of repetitive combined blast/impact mild traumatic brain injury in Iraq and Afghanistan war veterans.
abstract: Abstract Whether persisting cognitive complaints and postconcussive symptoms (PCS) reported by Iraq and Afghanistan war veterans with blast- and/or combined blast/impact-related mild traumatic brain injuries (mTBIs) are associated with enduring structural and/or functional brain abnormalities versus comorbid depression or posttraumatic stress disorder (PTSD) remains unclear. We sought to characterize relationships among these variables in a convenience sample of Iraq and Afghanistan-deployed veterans with (n=34) and without (n=18) a history of one or more combined blast/impact-related mTBIs. Participants underwent magnetic resonance imaging of fractional anisotropy (FA) and macromolecular proton fraction (MPF) to assess brain white matter (WM) integrity; [(18)F]-fluorodeoxyglucose positron emission tomography imaging of cerebral glucose metabolism (CMRglu); structured clinical assessments of blast exposure, psychiatric diagnoses, and PTSD symptoms; neurologic evaluations; and self-report scales of PCS, combat exposure, depression, sleep quality, and alcohol use. Veterans with versus without blast/impact-mTBIs exhibited reduced FA in the corpus callosum; reduced MPF values in subgyral, longitudinal, and cortical/subcortical WM tracts and gray matter (GM)/WM border regions (with a possible threshold effect beginning at 20 blast-mTBIs); reduced CMRglu in parietal, somatosensory, and visual cortices; and higher scores on measures of PCS, PTSD, combat exposure, depression, sleep disturbance, and alcohol use. Neuroimaging metrics did not differ between participants with versus without PTSD. Iraq and Afghanistan veterans with one or more blast-related mTBIs exhibit abnormalities of brain WM structural integrity and macromolecular organization and CMRglu that are not related to comorbid PTSD. These findings are congruent with recent neuropathological evidence of chronic brain injury in this cohort of veterans.
authors.affiliation: 1 Veterans Affairs (VA) Northwest Network (VISN 20) Mental Illness, Research, Education, and Clinical Center (MIRECC) , VA Puget Sound, Seattle, Washington.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Petrie
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Cross
authors.forename: Vasily L
authors.initials: VL
authors.lastname: Yarnykh
authors.forename: Todd
authors.initials: T
authors.lastname: Richards
authors.forename: Nathalie M
authors.initials: NM
authors.lastname: Martin
authors.forename: Kathleen
authors.initials: K
authors.lastname: Pagulayan
authors.forename: David
authors.initials: D
authors.lastname: Hoff
authors.forename: Kim
authors.initials: K
authors.lastname: Hart
authors.forename: Cynthia
authors.initials: C
authors.lastname: Mayer
authors.forename: Matthew
authors.initials: M
authors.lastname: Tarabochia
authors.forename: Murray A
authors.initials: MA
authors.lastname: Raskind
authors.forename: Satoshi
authors.initials: S
authors.lastname: Minoshima
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Peskind
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D016880:Anisotropy; D001753:Blast Injuries / Q000150:complications* / Q000473:pathology / Q000523:psychology; D001930:Brain Injuries / Q000150:complications* / Q000473:pathology / Q000523:psychology; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D059906:Neuroimaging; D009483:Neuropsychological Tests; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D014728:Veterans / Q000523:psychology*; D055815:Young Adult